This award will provide an opportunity for Dr. Kahn to develop as an independent scientific investigator in the field of clinical research investigating aspects of health care delivery in critical illness and acute lung injury. This will be accomplished through an integrated program of formal coursework in biostatistics and health services research, intensive mentoring by local experts, and practical experience in designing, conducting, and interpreting a clinical research project. Dr. Kahn will use this award to become a well-trained clinical investigator with skills in hierarchical multivariate statistical modeling and instrument development and validation. This will lead to a successful independent research career focused on understanding the organizational factors of intensive care units (ICUs) that are related to improved process of care and outcome in mechanically ventilated patients. The primary scientific goal of the study is to prospectively develop and validate an instrument to measure the organization of critical care services for mechanically ventilated patients in the ICU. This will be accomplished within the framework of the King County Lung Injury Project (KCLIP), a twenty-one hospital network developed to conduct population-based epidemiologic studies of patients with acute lung injury. Specific Aim One of the project uses directed interviews and focus groups within KCLIP ICUs to develop a brief survey instrument measuring important aspects of ICU organization. Specific Aim Two will test the reliability and validity of the instrument on the derivation cohort and use factor analysis to determine major independent components that comprise ICU organization (including physician staffing patterns, multidisciplinary care use, provider communication and overall ICU culture). Specific Aim Three will validate the instrument by measuring the association between the organization of ICU care with mortality and ICU length of stay in mechanically ventilated patients in a national sample. Relevance of this research to pubic health: This study will provide important information regarding how to best organize critical care services in order to provide optimal evidence-based care to patients with acute lung injury and respiratory failure. The instrument generated in this research will be used in future studies examining specific interventions to improve ICU organization. (End of Abstract)